Organizational system thinking as a cognitive framework to meet climate targets.

System thinking is a crucial cognitive framework to enable individual pro-environmental behavioral changes. Indeed, a large body of literature has shown a significant and positive association between individuals' system thinking capacities and perceptions of the threat posed by climate change. However, individual behavioral changes play a limited role in addressing climate change compared to large organizations involved in a significantly larger share of economic activities. Do organizations exhibit system thinking capacities? Here, we conjecture that system thinking is a cognitive framework observable at an aggregated group level and, therefore, organizations, not just individuals, can exhibit characteristic levels of system thinking. We conceptualize a definition of organizational system thinking and develop an empirical method to estimate it using a large body of textual data from business organizations. Then, we show that system thinking organizations are more likely to lower emissions and align them with the pathways required to meet the climate targets set by the Paris Agreement. Finally, we discussed the theoretical and policy implication of our study. Overall, our results suggest that system thinking is a relevant organization-level cognitive framework that can help organizations align their emissions with global climate targets.

Hiring women into senior leadership positions is associated with a reduction in gender stereotypes in organizational language.

Women continue to be underrepresented in leadership positions. This underrepresentation is at least partly driven by gender stereotypes that associate men, but not women, with achievement-oriented, agentic traits (e.g., assertive and decisive). These stereotypes are expressed and perpetuated in language, with women being described in less agentic terms than men. The present research suggests that appointing women to the top tiers of management can mitigate these deep-rooted stereotypes that are expressed in language. We use natural language processing techniques to analyze over 43,000 documents containing 1.23 billion words, finding that hiring female chief executive officers and board members is associated with changes in organizations' use of language, such that the semantic meaning of being a woman becomes more similar to the semantic meaning of agency. In other words, hiring women into leadership positions helps to associate women with characteristics that are critical for leadership success. Importantly, our findings suggest that changing organizational language through increasing female representation might provide a path for women to break out of the double bind: when female leaders are appointed into positions of power, women are more strongly associated with the positive aspects of agency (e.g., independent and confident) in language but not at the cost of a reduced association with communality (e.g., kind and caring). Taken together, our findings suggest that female representation is not merely an end, but also a means to systemically change insidious gender stereotypes and overcome the trade-off between women being perceived as either competent or likeable.

Nurturing a positive research culture within your organization.

Positive research cultures provide the environment for scientists to explore ideas, grow as individuals, develop team science and create a positive impact on those around them. While positive research cultures need to grow from the kindness and integrity of team members, organization policy can either help or hinder this organic positive behavior. A focus on policies to enhance positive research culture can benefit even high-functioning organizations, by expanding and extending the benefits. Here we focus on key actionable areas to create and reinforce a positive research culture in your organization. We discuss the role of aligning staff recognition to the organization's missions, the influence of the organization unit and career structure on the research culture, the pyramid of building respectful interactions, the value of openness and transparency and the overarching goal of equality, diversity and inclusivity within the organization.

Barriers to the implementation of antimicrobial stewardship programmes in long-term care facilities: a scoping review.

BACKGROUND: Long-term care facilities (LTCFs) present specific challenges for the implementation of antimicrobial stewardship (AMS) programmes. A growing body of literature is dedicated to AMS in LTCFs. OBJECTIVES: We aimed to summarize barriers to the implementation of full AMS programmes, i.e. a set of clinical practices, accompanied by recommended change strategies. METHODS: A scoping review was conducted through Ovid-MEDLINE, CINAHL, Embase and Cochrane Central. Studies addressing barriers to the implementation of full AMS programmes in LTCFs were included. Implementation barriers described in qualitative studies were identified and coded, and main themes were identified using a grounded theory approach. RESULTS: The electronic search revealed 3904 citations overall. Of these, 57 met the inclusion criteria. All selected studies were published after 2012, and the number of references per year progressively increased, reaching a peak in 2020. Thematic analysis of 13 qualitative studies identified three main themes: (A) LTCF organizational culture, comprising (A1) interprofessional tensions, (A2) education provided in silos, (A3) lack of motivation and (A4) resistance to change; (B) resources, comprising (B1) workload and staffing levels, (B2) diagnostics, (B3) information technology resources and (B4) funding; and (C) availability of and access to knowledge and skills, including (C1) surveillance data, (C2) infectious disease/AMS expertise and (C3) data analysis skills. CONCLUSIONS: Addressing inappropriate antibiotic prescribing in LTCFs through AMS programmes is an area of growing interest. Hopefully, this review could be helpful for intervention developers and implementers who want to build on the most recent evidence from the literature.

What's the CATCH? A Participatory Learning Model for Case Review Rounds to Support a Culture of Safety and Quality Improvement in Pediatric Hospital Medicine.

OBJECTIVE: To evaluate the effectiveness of a new model, Case Analysis and Translation to Care in Hospital (CATCH), for the review of pediatric inpatient cases when an adverse event or "close call" had occurred. STUDY DESIGN: The curricular intervention consisted of an introductory podcast/workshop, mentorship of presenters, and monthly CATCH rounds over 16 months. The study was conducted with 22 pediatricians at a single tertiary care center. Intervention assessment occurred using participant surveys at multiple intervals: pre/post the intervention, presenter experience (post), physicians involved and mentors experience (post), and after each CATCH session. Paired t-tests and thematic analysis were used to analyze data. Time required to support the CATCH process was used to assess feasibility. RESULTS: Our overall experience and data revealed a strong preference for the CATCH model, high levels of engagement and satisfaction with CATCH sessions, and positive presenter as well as physicians-involved and mentor experiences. Participants reported that the CATCH model is feasible, engages physicians, promotes a safe learning environment, facilitates awareness of tools for case analysis, and provides opportunities to create "CATCH of the Day" recommendations to support translation of learning to clinical practice. CONCLUSIONS: The CATCH model has significant potential to strengthen clinical case rounds in pediatric hospital medicine. Future research is needed to assess the effectiveness of the model at additional sites and across medical specialities.

(RE-)AIMing for Rapid Uptake: Pilot Evaluation of a Modified Hub and Spoke Model of Medication for Opioid Use Disorder.

OBJECTIVE: Medication for opioid use disorder (MOUD) is an effective, evidence-based treatment, but significant gaps in implementation remain. We evaluate one novel approach to address this gap: a Hub and Spoke model to increase buprenorphine access and management. METHODS: This outcome evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using secondary data analysis of clinical and administrative data to characterize program outcomes for program Reach, Effectiveness, Adoption, and Maintenance. Implementation was assessed through a chart review of provider progress notes and through key informant interviews with program staff to understand why this site was able to introduce a novel approach to MOUD. RESULTS: Nearly half of patients with opioid use disorder (45.48%, n=156) were reached by the program over 2 years. Of those, 91.67% had 1 or more program visits after an initial intake appointment, and 78.85% had a buprenorphine prescription. Patients in the program were 2.44 times more likely to have a buprenorphine prescription than those in comparator site that did not have a Hub and Spoke program (95% CI: 1.77-3.37; P <0.001). There was significantly greater program reach in year 1 than year 2, suggesting rapid initial uptake followed by modest program growth. Key informant interviews illustrated several themes regrading program implementation, including the importance of process champions, the beneficial impact of MOUD for patients, and addressing facility performance metrics. A supportive organizational culture and a receptive climate were also key factors for implementation. CONCLUSIONS: This program led to rapid improvement in MOUD uptake across the facility. Future efforts should focus on improving program maintenance, including supporting the exchange of patients from the hub to appropriate spokes.

Leaders need to look in the mirror.

PURPOSE OF REVIEW: There is commonly a discrepancy between optimal physician leader behavior and actual physician leader behavior. Identifying and addressing this discrepancy is essential to optimize culture in high-risk care units. RECENT FINDINGS: Unit culture is directly linked to improving well tolerated and effective care. Adoption of strategies to better address bad behavior is necessary. SUMMARY: To address a toxic culture in a high-risk unit, physician leaders must first look inwards and take personal responsibility for their actions and words. It is a much easier task to talk about healthy culture than it is to walk it.

Bad behavior in healthcare: an insidious threat to patients, staff, and organizations.

PURPOSE OF REVIEW: 'Bad' or unprofessional behavior (UPB) destroys communication, teamwork, and professional wellbeing, presenting a significant threat to patients and staff. Understanding what constitutes 'bad' or UPB and creating broad accountability for its cessation is imperative to patient-centered care and the survival of the multidisciplinary health workforce. RECENT FINDINGS: Despite organizational and legislative commitments to provide well tolerated work environments, UPB is endemic in healthcare and continues to harm patients, staff, and organizations. Historically, categories of UPB have been researched separately which dilutes the problem. Typically, these behaviors cluster, are interchangeable, and are committed by same perpetrators. Women, junior staff, and minority groups remain the most prevalent targets. Even low intensity UPBs among health staff dramatically impacts risk to patient lives, limits quality care, and destroys staff wellbeing. Targeted interventions must address all five roles impacted by UPBs: the target, patients, bystanders, the perpetrator, and the organization to effectively eliminate UPBs. Organizational leaders must demonstrate and uphold organizational values and be swift in addressing UPB to limit the impact on teams and patients. SUMMARY: UPB in the healthcare setting presents a multifactorial threat to patients, staff, and organizations. To ensure the delivery of high-quality patient care, and the wellbeing of the health workforce it is crucial to understand the insidious impact of UPB and target interventions across all five roles.

Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction.

BACKGROUND: Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members. OBJECTIVE: Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction. DESIGN: We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout. PARTICIPANTS: Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174). MAIN MEASURES: Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. 31 and Walling et al. 32 RESULTS: Thirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05). CONCLUSIONS: Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.

Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios.

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, P <0.05) and medical group-owned (OR = 2.09, P <0.05) practices were more likely to have ratios of 2 or more MAs per PCCs, as were practices with organizational cultures oriented to innovation (P <0.05). Most primary care practices do not have adequate MA staffing.

Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery.

PURPOSE: Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units. METHODS: Using a cross-sectional design, we surveyed Iowa physicians, nurses, and midwives delivering intrapartum care at hospitals participating in a quality improvement initiative to decrease the incidence of cesarean delivery. We linked respondents with their hospital characteristics and outcomes data. The primary outcome was the association between FM physician, obstetrician (OB), or both disciplines' presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or Both). RESULTS: A total of 849 clinicians from 39 hospitals completed the survey; 13 FM-only, 11 OB-only, and 15 hospitals with both. FM-only hospitals were all rural, with <1,000 annual births. Among hospitals with <1,000 annual births, births at FM-only hospitals had an adjusted 34.3% lower risk of cesarean delivery (adjusted incident rate ratio = 0.66; 95% CI, 0.52-.0.98) compared with hospitals with both. Nurses endorsed unit norms more supportive of vaginal birth and stronger safety culture at FM-only hospitals (P <.05). CONCLUSIONS: Birthing hospitals staffed exclusively by FM physicians were more likely to have lower cesarean rates and stronger nursing-rated safety culture. Both access and quality of care provide strong arguments for reinforcing the pipeline of FM physicians training in intrapartum care.

PeerOnCall: Exploring how organizational culture shapes implementation of a peer support app for public safety personnel.

BACKGROUND: Public safety personnel (PSP) such as firefighters, paramedics, and police are exposed to traumatic situations, which increase their risk for mental health issues. However, many PSP do not seek help in a timely manner. Peer support interventions have the potential to decrease stigma and increase treatment-seeking behaviours among PSP. However, little is known regarding how the organizational culture of public safety organizations (PSOs) affects the implementation of a peer-based intervention. This study aims to understand the extent to which organizational culture, including masculinity contest cultures (MCC), within Canadian PSOs could affect implementation of PeerOnCall, a new peer support app for PSP. METHODS: A qualitative multiple case study design was adopted, integrating semi-structured interviews with organizational champions from five PSOs. One to three champions from each PSO acted as key informants regarding their organizations. Interviews explored champions' perceptions of how organizational culture might shape implementation. Interview data were analyzed using inductive thematic analysis. RESULTS: Three themes were identified in analysis of the champion interviews. The first theme focused on external drivers and the second theme focused on internal drivers of organizational culture shift. The third theme focused on how culture can create resistance to implementation. Importantly, the MCC norm of show no weakness was described as a source of potential resistance when implementing the app. CONCLUSIONS: Each PSO had a unique and changing culture. Understanding how champions anticipate the role of culture in shaping implementation of an app-based intervention like PeerOnCall can guide the creation of contextually relevant strategies that optimize implementation within PSOs. Recommendations for optimizing implementation and areas for further study are provided.

What constitutes an employer of choice? A qualitative triangulation investigation.

Employer of choice (EOC) is a relatively new phenomenon, particularly in Human Resources Management. Existing employees and prospective talent have reasons and expectations to designate an employer as an EOC. While EOC has received extensive attention from both academics and practitioners over the past few years, the work has mostly focused on managerial and marketing perspectives, and thus far lacks a strong theoretical foundation. Drawing on Social Exchange Theory (SET), based on Human Resources and employees' perceptions and experiences, this research aims to explore and investigate the factors that constitute/designate an employer as an Employer of Choice EOC. Two qualitative triangulated data sets were collected from existing full-time employees at a Saudi multinational corporation: open interviews and document analysis (cross-sectional and longitudinal). Thematic analysis (TA) was employed to analyze both methods. The findings reveal that company image, training, and development, satisfaction, involvement and commitment, fairness, work culture, reward, opportunities for growth, teamwork, motivation, and corporate social responsibility are the factors that lead employees to designate an employer as an EOC. This research contributes to knowledge conceptually, theoretically, and empirically, mainly in the area of Human Resources Management. This research represents one of the first studies to empirically identify and investigate employee-related factors and evaluate them all together in a multinational Saudi organization. Recognizing the findings of this empirical-based research assists HR managers in designating their organizations as an EOC for current employees and prospective talents.

The influence of hospital accreditation on nurses' perceptions of patient safety culture.

OBJECTIVES: Hospitals' accreditation process is carried out to enhance the quality of hospitals' care and patient safety practices as well. The current study aimed to investigate the influence of hospitals' accreditation on patient safety culture as perceived by Jordanian hospitals among nurses. METHODS: A descriptive cross-sectional correlational survey was used for the current study, where the data were obtained from 395 nurses by convenient sampling technique who were working in 3 accredited hospitals with 254 nurses, and 3 non-accredited hospitals with 141 nurses, with a response rate of 89%. RESULTS: The overall patient safety culture was (71.9%). Moreover, the results of the current study revealed that there were no statistically significant differences between the perceptions of nurses in accredited and non-accredited hospitals in terms of perceptions of patient safety culture. CONCLUSION: The current study will add new knowledge about nurses' perceptions of patient safety culture in both accredited and non-accredited hospitals in Jordan which in turn will provide valid evidence to healthcare stakeholders if the accreditation status positively affects the nurses' perceptions of patient safety culture or not. Continuous evaluation of the accreditation application needs to be carried out to improve healthcare services as well as quality and patient safety.

Promotion or prevention: regulatory foci as moderators in the job demands-resources model.

BACKGROUND: Building on the job demands-resources (JD-R) model and regulatory focus theory, this study examined how regulatory foci shaped the effects of different job demands and resources on both negative and positive workplace outcomes among medical staff. METHODS: Two independent studies (NStudy 1 = 267; NStudy 2 = 350) were designed for cross-validation. Participants completed a battery of measures evaluating job demands (workload, emotional demands, interpersonal stress), job resources (psychological safety, perceived organizational support, servant leadership), and well-being (job burnout, affective commitment, job satisfaction). RESULTS: Multiple linear regression analyses showed employees' well-being was affected by job demands and resources through energetic and motivational processes, respectively. The deleterious effect of emotional demands on job burnout was pronounced in individuals with weak prevention focus (B = 0.392, standard error [SE] = 0.069, p < .001). Psychological safety (Study 1) and servant leadership (Study 2) had stronger positive associations with motivational outcomes among individuals with weak promotion focus than those with strong promotion focus (B = 0.394, SE = 0.069, p < .001; B = 0.679, SE = 0.121, p < .001; and B = 0.476, SE = 0.072, p < .001, respectively). CONCLUSION: We used two samples to examine and cross-validate the joint effects of job characteristics and personal traits on workplace well-being among Chinese medical staff. Although heterogenous, the results showed regulatory foci were especially important in determining the effects of job demands and resources on well-being when there was (autonomous) self-regulation in the workplace.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

BACKGROUND: Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. OBJECTIVE: To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). METHODS: We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. RESULTS: The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. CONCLUSIONS: Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

Investigating the Relationship Between Psychosocial Safety Climate and Mental Illness Stigma Among Emergency Medical Service Clinicians.

OBJECTIVES: To examine the relationship between psychosocial safety climate (PSC) and mental illness stigma among emergency medical service (EMS) clinicians. Despite the presence of mental health services at many EMS agencies, workers often do not seek treatment due to mental illness stigma. To facilitate treatment receipt and maintain a healthy workforce, we must understand factors contributing to stigma. Psychosocial safety climate refers to the degree to which workers perceive that their organization fosters a work environment focused on the protection of psychological health and safety. Despite its relevance, the relationship between PSC and mental illness stigma has yet to be examined. METHODS: Participants were recruited from EMS agencies in the Northeastern U.S. Census Region. We used an observational research design and multiple linear regression to investigate the relationship between overall levels of PSC using the Psychosocial Climate Scale (PSC-12) and mental illness stigma using the Endorsed and Anticipated Stigma Inventory - Workplace Stigma Subscale. We also examined separate facets of PSC to determine if one was more related to stigma. Using established guidelines and the Wilcoxon rank-sum test, we compared workers rating their agencies as having high-risk (≤37 points) or low-risk PSC levels (≥41 points). RESULTS: The sample was n = 124 EMS clinicians (Mage = 29.6, SDage = 9.2, 53.2% male). Most were White (88.7%) with some college/college degree (79.8%). After adjusting for age, gender, race, education, and mental health treatment receipt, clinicians reporting that their workplaces were less focused on psychosocial safety and health (i.e., lower overall levels of PSC) also reported elevated levels of stigma (b = -0.27, SE = 0.05, 95% CI = -0.37, -0.17, p < .001). Exploratory analyses indicated that no PSC facet was more related to stigma than another. Clinicians reporting high-risk levels displayed stigma levels that were 38% higher compared to clinicians reporting low-risk PSC levels. CONCLUSIONS: Psychosocial safety climate is an important and modifiable intervention target linked to mental illness stigma in EMS clinicians. Organizational policies, practices, and procedures that convey that mental health is valued and should be protected may reduce stigma and facilitate treatment receipt among this high-risk population.

Understanding the interplay between organisational injustice and the health and wellbeing of female police officers: a meta-ethnography.

BACKGROUND: Female police officers are reported to encounter more bias, discriminatory practices, and inadequate support than their male counterparts and experience poorer health outcomes. This meta-ethnographic review looks beyond individual responsibilities to consider which aspects of policing impact the health and well-being of female police officers. METHODS: Primary qualitative and mixed method studies published between 2000 and 2024 were included. ProQuest (all databases) and Ovid (Medline and Embase) were searched using terms related to health, wellbeing, females, police, and qualitative research. This was a cross-jurisdictional review, with no limit on country of study. In total, twenty-one papers met the inclusion criteria. A seven-phase inductive and interpretative meta-ethnographic technique was employed to synthesise, analyse, and interpret the data. RESULTS: The data analysis revealed a distinct outcome that demonstrated a strong relationship and substantial impacts of organisational injustice on the health and well-being of female police officers. Our findings showed that organisational injustice, encompassing procedural, relational, distributive, and gendered injustice, significantly influences the health and well-being of female officers. Impacts on mental health were commonly discussed, followed by aspects influencing social health, workplace wellbeing, and physical health. Moreover, the effects of these four forms of organisational injustice and the associated cultural, systemic, and structural risk factors extend beyond the immediate health and wellbeing impacts on the individual female officer through impeding other aspects of their work life, such as career progression and work-life balance, that can further impact long-term health and well-being. CONCLUSION: This review highlights the importance of addressing organisational injustice and the cultural, systemic, and structural risk factors within policing to promote healthier and more inclusive workforces for female officers. Policymakers and practitioners should critically examine policies and practices that may appear gender neutral but disproportionately impact women, affecting the health and well-being of female police officers. By addressing these issues, transformative action can be taken to create safer, more supportive, and healthier working environments for female police officers.

Predictive effects of organizational justice on job satisfaction in bus drivers: the moderating effects of role overload and proactive personality.

BACKGROUND: There have been few longitudinal studies on Chinese bus drivers and the individual differences in the relationships between organizational justice and job satisfaction. This study examined the organizational justice and job satisfaction in bus drivers and the individual differences in this relationship. METHODS: A two-wave longitudinal study design was employed. A first survey was conducted on 513 Chinese bus drivers in October 2021 that collected socio-demographic information and asked about their perceptions of organizational fairness. A second survey was conducted six months later that asked about role overload and job satisfaction and assessed their proactive personality type. An effect model was then used to explore the moderating effects of role overload and proactive personality type on the relationships between organizational justice and job satisfaction. RESULTS: Both procedural and interactive justice predicted the bus drivers' job satisfaction. Proactive personalities and role overload were found to enhance this relationship. CONCLUSIONS: Organizations could benefit from screening at the recruitment stage for drivers with highly proactive personalities. Relevant training for drivers with low proactive personalities could partially improve employee job satisfaction. When viewed from a Chinese collectivist cultural frame, role overload could reflect trust and a sense of belonging, which could enhance job satisfaction. Finally, to improve employee job satisfaction, organizations need to ensure procedural and interactive justice.

Assessing personal protective equipment usage and its correlation with knowledge, attitudes, performance, and safety culture among workers in small and medium-sized enterprises.

BACKGROUND: The use of personal protective equipment (PPE) should be a culture of a workplace, and deeply rooted in worker behavior and attitude during their practice. According to the recent studies only 64% of the workers use PPE properly. The present study aims to investigate the utilization of PPE among workers in small and medium-sized enterprises (SMEs), and its relationship with knowledge, attitude, performance, and safety culture among workers. METHODS: This cross-sectional study was carried out using a questionnaire tool across SMEs in Kashan city in year 2023. The used tool included three questionnaires: demographic, safety culture, and knowledge, attitude and performance. Study papulation was 529 SMEs. Totally, the sample size was 369 persons and questionnaires were distributed among the workers of SMEs. Finally, SPSS software was used for statistical analysis and structural equation modeling. Various statistical tests including T-Test, ANOVA, RMSEA, CFI, TLI, and the chi-square ratio were employed. RESULTS: The mean values (standard deviation) of age and work experience were 35.19 (12.33), and 15.60 (1.69) years, respectively. Among the 369 participants, 267 participants (72.4%) indicated that they use some PPE, although not all types. However, 102 individuals (27.7%) do not employ any PPE. The lowest score for safety culture dimension was attributed to safety training at 1.58. The results of the final model indicate that the assumed relationships between variables, as outlined in the study objectives, were well established, with all connections proving statistically significant. CONCLUSION: It can be concluded that the missing of inadequate legal supervision for small industries exists. Therefore, it can be inferred that if supervision and regulation are enhanced for safety training and implementation that may lead to increased usage of PPE.